title: Racial inequities in receipt of influenza vaccination among long-term care residents within and between facilities in Michigan.
abstract: BACKGROUND
  Although influenza vaccination is recommended for all nursing home residents and is covered by Medicare, racial inequities remain.
  
  
  OBJECTIVE
  To determine the extent of racial difference in influenza vaccination among nursing home residents within and between nursing facilities by facility resident racial composition in a state with a large White-Black difference in vaccination.
  
  
  METHODS
  Data from the Centers for Medicaid & Medicare Services' (CMS) Minimum Data Set (MDS) for assessments from October 1, 2005 through March 31, 2006. Facility-level data for nonhospital-administered CMS-certified nursing facilities in Michigan were merged with MDS.
  
  
  METHODS
  All nursing home residents (n=90,120).
  
  
  METHODS
  Receipt, refusal, or unvaccinated due to contraindication or not being offered the influenza vaccine.
  
  
  RESULTS
  The unadjusted influenza vaccination coverage of residents was 60.6%, 63.5% for whites, and 43.0% for blacks, a difference of 20.5 percentage points. The adjusted median range of inequity (white-black) within homes stratified by proportion blacks in the facility (eg, 0%, 1% to 4.9%, 5% to 19.9%, 20% to 49.9%, and ≥50%) was 5.0% to 5.6% points. White residents refused the vaccine less than black residents in all groups of homes by proportion blacks in the home, ranging from 7.6% [corrected] in the all white homes to 14.3% [corrected] among blacks in homes with >50% black residents. The adjusted median black deficit in not being offered the vaccine between nursing homes was large (up to 26.0% [corrected] points between all white homes and homes with >50% blacks).
  
  
  CONCLUSIONS
  Michigan statewide vaccination inequity among nursing home residents results from blacks disproportionately living in nursing homes where vaccination coverage is lowest. The inequity between facilities can be attributed to facility-level difference in offering.
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. bfb7@cdc.gov
authors.forename: Barbara
authors.initials: B
authors.lastname: Bardenheier
authors.forename: Pascale
authors.initials: P
authors.lastname: Wortley
authors.forename: Faruque
authors.initials: F
authors.lastname: Ahmed
authors.forename: Stefan
authors.initials: S
authors.lastname: Gravenstein
authors.forename: Carol J Rowland
authors.initials: CJ
authors.lastname: Hogue
mesh_terms: D001741:Black or African American; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008824:Michigan; D009735:Nursing Homes; D014481:United States; D044465:White People
chemical_list: D007252:Influenza Vaccines